Asfour H, Aram K, Hassouna M
… +4 more, Singhania N, Deric D, Yii N, Agarwal R
Ann Surg Oncol
· 2026 Jun · PMID 42249261
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BACKGROUND: Skin grafting after skin cancer excision is a commonly performed procedure. Preoperative identification and optimization of patients at risk of graft failure can improve outcomes and healthcare cost effective...BACKGROUND: Skin grafting after skin cancer excision is a commonly performed procedure. Preoperative identification and optimization of patients at risk of graft failure can improve outcomes and healthcare cost effectiveness. This study aimed to develop and internally validate a risk assessment tool, the skin Graft Risk Assessment of Failure Tool (GRAFT) to aid risk stratification of patients undergoing skin grafting after cancer excision. METHODS: A single-center retrospective cohort of 162 patients who underwent skin grafting after skin cancer excision was included. Relevant variables were assessed using univariate logistic regression. Variables demonstrating significant association were entered into multivariable modeling. Model discrimination and calibration were respectively assessed using the area under the receiver operating characteristic curve (AUC) and Hosmer-Lemeshow goodness-of-fit test. Bootstrapping was used for internal validation. RESULTS: Anticoagulation and cancer location demonstrated significant association with graft failure in the univariate analysis. In multivariable analysis, anticoagulation (odds ratio [OR] 6.40; 95% confidence interval [CI] 2.25-18.24) and lower body graft location (OR 3.19; 95% CI 1.21-8.45) remained independently associated with graft failure. The final model demonstrated acceptable discrimination (AUC 0.72), and the Hosmer-Lemeshow test showed no evidence of lack of fit (p = 0.87), with stable performance on bootstrap validation. The GRAFT score stratified patients into low-, intermediate-, and high-risk groups with observed failure rates of 7.5%, 26.0%, and 60.0%, respectively. CONCLUSION: The GRAFT score is an internally validated, simple, practical, bedside tool that estimates risks of skin graft failure after skin cancer excision, supporting clinical decision-making and patient counseling. External validation of this model is warranted.
Miyawaki Y, Fujiwara H, Shiko Y
… +7 more, Haruki S, Kumagai Y, Kaito A, Nakajima Y, Yamaguchi K, Sato H, Sakuramoto S
Ann Surg Oncol
· 2026 Jun · PMID 42247031
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BACKGROUND: Although prompt treatment is desirable for malignancies, surgical delays are sometimes unavoidable. Previous studies show conflicting results on the effect of diagnosis-to-surgery delay in esophageal cancer,...BACKGROUND: Although prompt treatment is desirable for malignancies, surgical delays are sometimes unavoidable. Previous studies show conflicting results on the effect of diagnosis-to-surgery delay in esophageal cancer, mainly focusing on advanced stages treated preoperatively. Early stage disease, particularly cT1bN0, often involves longer waiting times, but the acceptable delay remains unclear. We conducted this study to evaluate the impact of surgical waiting time on postoperative survival in patients with clinical T1bN0M0 esophageal squamous cell carcinoma (ESCC) undergoing upfront esophagectomy. PATIENTS AND METHODS: This multicenter retrospective study included 160 patients with cT1bN0M0 ESCC undergoing subtotal esophagectomy with lymphadenectomy at seven Japanese institutions between 2008 and 2021. Receiver operating characteristic (ROC) analysis identified the optimal waiting time cutoff predicting recurrence. Survival outcomes were compared between short and long waiting groups using the Kaplan-Meier method and Cox regression analyses. RESULTS: ROC analysis identified 66.5 days as the optimal cutoff value. The long waiting group (≥ 67 days) showed significantly worse 3-year recurrence-free survival (87.9% versus 73.5%, log-rank P < 0.01; hazard ratio 2.71, 95% confidence interval 1.29-5.70, P < 0.01), whereas cancer-specific survival showed no significant difference. Multivariate analysis identified prolonged waiting time, pathological T2 or deeper invasion, and lymph node metastasis as independent predictors of recurrence, with longer delays linked to increased systemic recurrence beyond 2 years postoperatively. CONCLUSIONS: In patients with cT1bN0 ESCC, surgical delay beyond approximately 2 months independently increases postoperative recurrence. It is suggested that planning surgery without delay reduces the risk of recurrence; however, verification in a larger cohort is necessary.
Martos Rodríguez M, Sudour-Bonnange H, Ducou Le Pointe H
… +17 more, Lemelle L, Bonneau-Lagacherie J, Pasqualini C, Boulanger C, Notz-Carrere A, Mansuy L, Pluchart C, Rod J, Jannier S, Sirvent N, Plantaz D, Klein S, Andry L, Verschuur A, Dumont B, Audry G, Irtan S
Ann Surg Oncol
· 2026 Jun · PMID 42243384
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BACKGROUND: Management of bilateral Wilms tumor (BWT) to achieve complete tumor control and maintain good long-term renal function is challenging. Nephron-sparing surgery (NSS) allows preservation of renal parenchyma and...BACKGROUND: Management of bilateral Wilms tumor (BWT) to achieve complete tumor control and maintain good long-term renal function is challenging. Nephron-sparing surgery (NSS) allows preservation of renal parenchyma and reduces the risk of renal failure in selected cases. However, there is no standardized surgical strategy. This study analyzed the surgical management for patients included in the SIOP2001 trial and its outcomes. METHODS: This retrospective review analyzed French patients included in the SIOP 2001 protocol for synchronous BWT. Data regarding imaging, surgical strategy, complications, histology, oncologic outcomes, and renal function were collected. RESULTS: The study included 96 patients (median age, 15 months; range, 0-143 months). They received surgery for 122 Wilms tumors, and 56 (45.9 %) kidneys benefited from NSS. Total nephrectomy (TN) was performed in 27/35 (77.1 %) and 33/76 (43.4 %) of the histologies non-sensitive to chemotherapy (stromal and diffuse anaplasia, respectively). For bilateral surgery, the study found a trend to more TNs, tumoral rupture, and death among the patients who had surgery in a single stage (p > 0.05). Tumor rupture was associated with higher tumoral volume (p < 0.05). In a review of preoperative images, vascular contact was the main factor associated with TN. Additional chemotherapy did not seem to significantly reduce this contact or the number of TNs in these patients. CONCLUSION: Whenever possible, NSS should be prioritized for patients with BWT. In this study, the most limiting factor was contact with vascular structures. Additional chemotherapy for tumors with non-sensitive histology or extensive vascular contact had little impact on the final surgical strategy. Staged surgery should be considered as it appeared to reduce surgical morbidity.
Frey MC, Lopez-Lopez V, Benz A
… +12 more, Abdurakhmonov S, Amirian H, Datta J, Lee SH, Yoo C, Pu N, Zhang C, Reames BN, Fritsch R, Petrowsky H, Oberholzer J, Eshmuminov D
Ann Surg Oncol
· 2026 Jun · PMID 42236648
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BACKGROUND: In recent years, neoadjuvant therapy (NAT) has received growing interest and is now the standard of care for borderline resectable (BR) pancreatic cancer (PC) and locally advanced (LA) PC. Despite the proven...BACKGROUND: In recent years, neoadjuvant therapy (NAT) has received growing interest and is now the standard of care for borderline resectable (BR) pancreatic cancer (PC) and locally advanced (LA) PC. Despite the proven benefits of both NAT and adjuvant therapy (AT), a critical question remains: whether patients undergoing pancreatectomy after NAT still benefit from additional adjuvant chemotherapy. In this systematic review and meta-analysis, we aimed to answer that question and explore potential subgroups and regimens that increase or decrease a potential survival advantage. METHODS: A comprehensive systematic literature search was performed. The primary outcome measure was overall survival (OS), expressed as hazard ratios (HRs). HRs and their corresponding 95% confidence intervals (CIs) were collected to compare survival between patients who did and did not receive AT. The ROBINS-I-tool was used to assess the risk of bias for all included non-randomized studies. RESULTS: Overall, 29,119 patients from 30 articles with PC who underwent NAT and surgical resection with reporting of AT were included. Patients who received AT after NAT and surgical resection demonstrated a significantly longer OS, with a pooled HR of 0.85 (95% CI 0.8-0.89; p<0.0001). Patients with N0 disease gained benefit from AT, with an HR of 0.87 (95% CI 0.80-0.94; p=0.0008). AT after NAT in patients with N+ disease demonstrated an even clearer improved OS, with an HR of 0.74 (95% CI 0.65-0.85; p<0.0001). CONCLUSION: AT after NAT and surgical resection may improve OS, especially for patients with a positive nodal status, but, importantly, also for patients with a negative nodal status. Future studies should focus on detailed reporting of chemotherapy regimens and resectability criteria.
Riner AN, Alobuia W, Walsh A
… +5 more, Grignol VP, Contreras CM, Pawlik TM, Tsai S, Cloyd JM
Ann Surg Oncol
· 2026 Jun · PMID 42234360
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BACKGROUND: Multidisciplinary tumor board (TB) meetings are used to generate consensus recommendations for the diagnosis and management of patients with cancer, yet no documentation standards exist. Since lack of documen...BACKGROUND: Multidisciplinary tumor board (TB) meetings are used to generate consensus recommendations for the diagnosis and management of patients with cancer, yet no documentation standards exist. Since lack of documentation could contribute to patient outcomes, we aimed to characterize TB documentation practices at a single institution. PATIENTS AND METHODS: A retrospective audit of patients discussed at six TBs at a National Cancer Institute (NCI)-designated comprehensive cancer center from January 2024 to June 2024 was conducted. The presence and quality of TB documentation in the medical records were recorded. Associations with clinicodemographic variables and patient outcomes were assessed. RESULTS: Among 991 patients (307 liver, 235 breast, 166 colorectal, 153 pancreas, 110 cutaneous, 20 gastroesophageal), the median age was 63 years, 84.5% were white, 52.5% were female, and 65.7% had locoregional disease. Documentation was present in only 51.7% but varied by disease site (5.5% for breast to 97.0% for colorectal, p < 0.001). Among patients with documentation, 44.7% of notes were unstructured with variable content: 99.2% documented consensus recommendations, 58.0% listed the information reviewed, 29.3% listed attendees' specialties, 11.3% documented the reason for discussion, and 15.8% documented clinical trial eligibility. In total, 55.7% of notes documented if patients were notified of the recommendations, most commonly via phone (71.8%). CONCLUSIONS: In this retrospective study, the presence and quality of documentation in the medical records are highly variable following discussion at a multidisciplinary TB meeting and could serve as a surrogate for high-quality multidisciplinary cancer care. Developing standards for TB documentation may improve accurate and timely dissemination of consensus recommendations and delivery of complex cancer care.